Eustachian Tube Dysfunction or Blockage: Symptoms & How to Clear Share Your Story The Eustachian tube originates in the rear of the nose adjacent to the soft palate, runs a slightly uphill course, and ends in the middle ear space. The Eustachian tube connects the middle ear space to the rear of the nose near the soft palate. The middle ear space is the hollowed out portion of the skull bone that contains the hearing apparatus and is covered on one side by the eardrum. Cartilage provides the supporting structure for the first two-thirds of the Eustachian tube, with the last third (the part closest to the middle ear space) being made of bone. In adults, the Eustachian tube is approximately 35 mm long (1.3 inches) and approximately 3 mm in diameter (less than 1/10 inch). The tissue that lines the Eustachian tube is similar to that inside the nasal cavity and may respond the same way (swelling and mucous production) when presented with similar stimuli. Normally, the Eustachian tube is closed, but it can become partially or completely blocked as a consequence of common colds or allergies.

Partial or complete blockage of the Eustachian tube can cause sensations of popping, clicking, and ear fullness. Altitude changes can cause symptoms in persons with Eustachian tube problems. Several maneuvers can be done to improve Eustachian tube function. The Eustachian tube was named in honor of the 16th century Italian anatomist Eustachius. Sources credit Almaceon of Sparta as the first to describe the structure in approximately 400 BC. What is the function of the Eustachian tube? The primary function of the Eustachian tube is to ventilate the middle ear space, ensuring that its pressure remains at near normal environmental air pressure. The secondary function of the Eustachian tube is to drain any accumulated secretions, infection, or debris from the middle ear space. Several small muscles located in the back of the throat and palate control the opening and closing of the Eustachian tube. Swallowing and yawning cause contractions of these muscles located in the back of the throat and help regulate Eustachian tube function.

If it were not for the Eustachian tube, the middle ear cavity would be an isolated air pocket inside the head that would be vulnerable to every change in air pressure and lead to unhealthy middle ear space function. Normally, the nasal opening of the Eustachian tube is closed, which helps prevent the inadvertent contamination of the middle ear space by the normal secretions found in the back of the nose. A dysfunctional Eustachian tube that is always open is called a "patulous" Eustachian tube. Patients with this rare condition are plagued by chronic ear infections . A much more common problem is a failure of the Eustachian tube to effectively regulate air pressure. Partial or complete blockage of the Eustachian tube can cause sensations of popping, clicking, and ear fullness and occasionally moderate to severe ear pain. Such intense pain is most frequently experienced during sudden air pressure changes during airplane travel, particularly during take-off and landing. Young children may describe the popping sensation as "a tickle in my ear" or "my ears are itching ." If the Eustachian tube function worsens, air pressure in the middle ear falls, and the ear feels full and sounds are perceived as muffled.

Eventually, a vacuum is created which can then cause fluid to be drawn down the Eustachian tube into the middle ear space (termed serous otitis media). If the fluid becomes infected, the common ear infection (suppurative otitis media) develops. Picture of the Structures of the Inner Ear What causes Eustachian tube dysfunction or blockage? Eustachian tube problems and the associated ear infections are among the most common problems seen by health-care professionals. Many people have chronic problems regulating middle ear pressure. The Eustachian tube can be blocked, or obstructed, for a variety of reasons. The most common cause is a " cold " (upper respiratory infection). Sinus infections and allergies may also cause swelling of the tissue lining the Eustachian tube. Simply put, a stuffy nose leads to stuffy ears. Children are particularly prone to Eustachian tube blockage because their tubes are narrower in diameter, more horizontal in orientation, and closer at the nasal opening of the Eustachian tube to the adenoids . Adenoid tissue in the back of the nose near the Eustachian tube can act as a reservoir for bacteria, contributing to recurrent ear infections .

Enlarged adenoids obstructing the opening of the Eustachian tube may also be present. Adenoid removal ( adenoidectomy ) is frequently recommended in children with chronic ear infections (chronic otitis media). Rarely, masses or tumors in the skull base or nasopharynx can lead to Eustachian tube obstruction. Excessively small Eustachian tubes (as may afflict children with Down Syndrome ) Smoking is associated with damage to the cilia that sweep mucus and debris from the middle ear space via the Eustachian tube to the back of the nose where it may be expelled. Causes range from allergies to excessively small Eustachian tubes (as may afflict children with Down Syndrome ). Medically Reviewed by a Doctor on 12/7/2016 The Inner Workings of the Inner Ear - Ear, Nose, and Throat Center - Everyday Health We respect your privacy . Eustachian tubes help maintain normal air pressure in the middle ear, in response to changes in pressure in the external environment. But when sinus congestion from a cold or allergies blocks these tubes, you could develop a variety of problems, including ear infections . What exactly is a eustachian tube?

It's a small canal, about one and one-half inches long and only a few millimeters in diameter, that serves as a passageway connecting the back of your throat and nose to your middle ear, where your eardrum is located. Eustachian tubes are lined with the same kind of moist membrane that lines the nose and throat. They are typically closed, but they open with movements of the back of the nose and throat, such as those that occur when you swallow, yawn, or talk. Adult eustachian tubes are angled downward from the ear into the back of the throat, allowing for gravity drainage of middle ear fluids and mucus . Your middle ear translates sounds that enter your outer ear into vibrations that can be understood by your inner ear and brain. To work properly, your middle ear should maintain the same air pressure as the air pressure around you. So your eustachian tubes open up periodically to circulate air throughout your middle ear, equalizing its air pressure to the pressure in the back of your throat. Another function of your eustachian tubes is to allow any mucus buildup in your middle ear to drain out into your throat.

When Your Eustachian Tubes Malfunction A number of things can go wrong with your eustachian tubes and middle ear, including: Blockage due to swelling. It is not uncommon for people with sinus pressure to experience middle ear blockage due to congestion of the eustachian tubes. This swelling is most commonly caused by a sinus infection , a cold, or allergies. These conditions can cause the inner ear membranes to swell and block the tubes. A blocked eustachian tube cannot circulate air or drain mucus as it should. Mechanical blockage. Sometimes overgrowth of tissues in the back of the nose (such as nasal polyps or the adenoids) can cause ear blockage by obstructing the eustachian tube opening. On rare occasions, a tumor can cause a blockage. Otitis media (middle ear inflammation or infection). When sinus congestion leads to a blocked eustachian tube, fluid can accumulate in the middle ear and cause it to become inflamed. Similarly, if you have a bacterial sinus infection that spreads into your eustachian tubes, it can cause a middle ear infection, which leads to swelling and more fluid buildup. Otitis media is associated with ear pain and pressure.

Ruptured eardrum. If too much fluid builds up in your inner ear, it could tear your eardrum. Speech, Language, and Hearing Problems Particularly in children, eustachian tube blockages can result in: Hearing problems. Excess fluid in the middle ear can result from a blocked eustachian tube, which can interfere with normal hearing, since fluid makes it difficult for the eardrum and bones in the inner ear to vibrate properly in response to sound. This type of hearing loss is usually temporary, but if left untreated, it can become permanent. Speech and language problems. In young children, the hearing impairment caused by frequent middle ear infections can lead to disabilities with speaking and understanding language. Eustachian tube-related problems are more common in children than adults, partly because eustachian tubes are not fully developed in children, and tend to be shorter and straighter than those in adults. Chronic or recurrent eustachian tube blockages are sometimes referred to as eustachian tube dysfunction. When Outside Forces Harm the Eustachian Tubes It’s not just allergies and infections that can cause eustachian tube issues. Other causes include: Discomfort during air travel.

Most people who have traveled by air are familiar with the sensation of increased pressure and popping in the ears, especially when the airplane is landing. This happens because your middle ear cannot keep up with rapid air pressure changes, and the pressure within your ears is lower than the air pressure around you, which increases as a plane descends. You can help keep your ears clear during air travel by doing things to open the eustachian tube, such as swallowing often, chewing gum, and yawning frequently. Barotrauma. When the pressure in your middle ear is different than the pressure outside of your body for an extended period of time (for example during flight, scuba diving, or driving in very high altitudes), it can lead to severe discomfort, and even eardrum damage. This type of damage is called barotrauma (baro is from the word barometric, which relates to atmospheric pressure). Barotrauma can cause you to feel dizzy, have ear pain, and experience pressure in your ears. Symptoms of severe barotraumas include ear drum rupture, hearing loss, and nosebleeds.

Treatment Options for Eustachian Tube Problems If you have persistent pain or pressure in your ears, or suspect you or your child has a eustachian tube-related problem, see your doctor. The following may help manage fluid buildup and even infection in your middle ear: Eustachian-tube opening strategies such as swallowing and chewing are useful, and your doctor can teach you a breathing technique called a valsalva maneuver, which if done gently, may open a clogged eustachian tube. Intranasal steroid sprays may help, especially if allergies are causing the problem. Some doctors recommend use of an oral decongestant if the eustachian tube blockage accompanies a cold or sinus infection. Antibiotics may be prescribed if there is a suspected bacterial ear infection. Surgical insertion of tubes in the eardrums helps ventilate the middle ear outwardly, via the external ear canal, and to drain fluids that way as well. If left untreated, eustachian tube problems can lead to permanent hearing loss, serious infection, or other long-term complications. So if you or your child is experiencing problems, be sure to let a doctor know.

The Structure of the ear | Family Doctor Checkout The Structure of the ear The human ear is one of the more remarkable parts of the human body, not only because of the beauty and unlikelihood of its structure, but also because of its remarkable sensitivity to sounds. From an anatomical point of view, the ear is conventionally and conven­iently divided into three parts: the outer, the middle and the inner ears. THE OUTER EAR The outer ear comprises the pinna (auricle), which is made of a convoluted plate of flexible cartilage that extends as a nearly closed tube one-third of the way down the ear canal. This outer third, which is about eight millimetres (one-third of an inch) long, has small hairs that point outwards to form a line of defence against small animals creeping in. The roots of the hairs produce oils and these mix with the secretions from nearby sweat-like glands to form the basis of wax. The deep two-thirds of the ear canal (16 millimetres/two-thirds of an inch long) has a bony wall lined with thin and rather fragile skin which is devoid of glands.

At the far end of the ear canal and stretched across it is the eardrum (tympanic membrane), which forms the boundary between the outer and middle ears. THE MIDDLE EAR (TYMPANUM) The eardrum is a circle of thin skin about eight to nine millimetres (one-third of an inch) in diameter. Despite its name, it is not flat like the skin of a drum, but is slightly conical with the curved sides sloping inwards. The eardrum has three layers. The outer layer In contact with the deep ear canal, the outer layer is covered with a thin layer of skin. The inner layer The inner layer is in continuity with the lining of the middle ear, and consists of rather flat cells that have the ability to transform into the type of cells that line the nose and sinuses. Following infection, chemical irritation – such as tobacco smoke – or allergy, these cells alter and produce mucus which flows into the middle ear.

The middle layer The middle layer of the eardrum is very important and consists of elastic fibres arranged both like the spokes of a wheel (radial fibres) and in circles (circumferential fibres), so that this layer is like a sprung trampoline net. The larger lower three-quarters of the eardrum (the pars tensa) is tense and absorbs sound. The smaller upper portion of the membrane is more floppy because the fibres of the middle layer are not organised in regular patterns, and this region is called the pars flaccida. The middle ear itself (the tympanum) lies deep to the eardrum and is an air-filled space that holds three small bones (ossicles), which connect the eardrum to the inner ear. These bones are called the hammer (malleus), anvil (incus) and stirrup (stapes) because of their resemblance to these objects. The hammer has a handle and a head and the handle lies within the layers of the eardrum.

The head of the hammer sits in the upper part of the middle-ear space called the attic (epitympanum) and is connected by a joint – just the same as any other joint in the body – to the rather bulky body of the anvil. From the anvil, a long strut (the long process) descends back into the middle ear proper and is connected to the head of the stirrup. The two arches (crura) of the stirrup join the footplate, which sits in a small (3 mm × 2 mm) hole in the skull called the oval window (fenestra ovalis). This is the opening into the fluid-filled space of the inner ear. Just below the oval window is another small hole into the inner ear called the round window (fenestra rotunda). A thin membrane closes this and, when the footplate of the stirrup moves ‘in and out’, the round window membrane moves ‘out and in’ because the fluid in the inner ear transmits the pressure changes. The hammer and anvil are supported in the middle ear by several membranes and ligaments, which minimise their weight, allow them to move easily and bring them a blood supply.

Unfortunately, this leaves only a small space for the passage of air from the middle ear to the attic. Running through the middle ear is the facial nerve (nerve VII or the seventh nerve). This nerve leaves the brain and has to pass through the skull on its way to supply the muscles of facial expression, that is, muscles for frowning, winking, smiling, scowling, and so on. The nerve lies in a thin bony tube and runs horizontally from the front to the back of the middle ear just above the oval window and stirrup, before it turns downwards to leave the base of the skull. The nerve then turns forwards to reach the face. The facial nerve is therefore relatively vulnerable in diseases of the middle ear and, indeed, in middle-ear surgery itself. A facial palsy results in one side of the face being paralysed, so that the face droops and fails to move. Smiling results in a scowl and drinking in dribbling, and the eye fails to close on blinking. Running through the eardrum is the nerve that carries taste from the front two-thirds of the tongue (the chorda tympani nerve).

This nerve is on its way to join the facial nerve in the middle ear where it ‘hitch-hikes’ a lift back to the brain. Finally, there are two small muscles in the middle ear. The one at the front (tensor tympani) is attached at the top of the handle of the hammer and tenses up the eardrum when swallowing activates it. The function of this muscle is not clear but it may be to make eating and swallowing a less noisy event. The muscle at the back of the middle ear (stapedius) arises near the facial nerve, is supplied by it and attaches to the head of the stirrup. It responds to loud sounds by contracting and stiffening the chain of small bones, and possibly reduces transmission of prolonged and potentially damaging, loud sounds to the inner ear. THE INNER EAR (LABYRINTH) The inner ear is probably the most remarkably intricate piece of the body. It makes hearing possible by converting sound into electrical impulses that then travel along the hearing nerve (the acoustic nerve or auditory nerve) to the brain. The inner ear also plays a major role in balance.

The balance portions of the inner ear (vestibular labyrinth) can detect acceleration of the head in any direction whether in a straight line (linear) or twisting and turning (angular). The electrical signals that arise in response to head move­ment pass along the balance nerve (vestibular nerve), which in due course joins with the hearing nerve to form a single bundle (stato­acoustic, vestibulo-acoustic or eighth nerve, nerve VIII) which then enters the brain. The portion of the inner ear that actually hears is the cochlea. This is a hollow coiled tube set in the very dense bone called the bony labyrinth (part of the petrous [rock­like] temporal bone). This tube is filled with fluid, which is much the same as general body fluid (lymph) and that which surrounds the brain (cerebrospinal fluid – CSF). This inner-ear fluid is called perilymph. Inside the perilymph is another coiled triangular-shaped tube called the cochlear duct (scala media), which contains the all-important ‘hair cells’ – these convert sound into electricity. These hair cells are arranged in two groups that follow the coils of the cochlear duct and spiral upwards from base to apex.

There is a single row of inner hair cells (IHCs), which lie closer to the core of the cochlea (modiolus), and three or four rows of outer hair cells (OHCs), which are further away. In a healthy young human ear there are about 3,500 IHCs and about 12,000 OHCs. Each hair cell has a cluster of small rigid hairs (stereocilia), which project from the thicker upper surface of the cell into the special fluid that fills the cochlear duct. This fluid is called endolymph and is remarkable in that it has a strongly positive electrical charge associated with it – about 80 millivolts – and is rich in potassium, a metallic element. The hair cells in their rows are grouped together with their supporting cells in the organ of Corti. This is a small ridge that sits on a thin, very flexible membrane called the basilar membrane. The basilar membrane forms the floor of the triangular cochlear duct. The sloping roof is another very thin membrane (Reissner’s membrane) and the side wall is a thickened region rich in blood vessels (the stria vascularis).

This structure is responsible for maintaining the composition of the rather unusual and very important endolymph. Adjacent to the base of the hair cells are the nerves that carry impulses to the brain (the afferent nerves). At least 90 per cent of these nerves come from the inner hair cells, despite their smaller number. Each inner hair cell has about 10 nerve endings attached to it and there are, therefore, about 30,000 nerve fibres in the acoustic nerve. The outer hair cells have nerves attached to them but most are nerves coming from the brain (the efferent nerves), whose function is described later. The hearing nerves travel inwards, along with the balance and facial nerves, through a canal in the inner part of the skull (variously called the internal auditory meatus [IAM], internal auditory canal [IAC] or porus acousticus) to reach the brain stem. This part of the brain deals with lots of automatic functions such as pulse, blood pressure, general alertness, balance, and so on.

About half of the hearing nerves from each ear cross over to the other side of the brain stem and then, on both sides, the nerves pass up the brain stem through the mid­brain, eventually to reach ‘conscious­ness’ in what is called the cortex of the brain. For hearing, this conscious region is located in the temporal lobe portion of the brain, which lies on each side of the head just above the ear. SOUND AND HOW THE EAR WORKS Sound Sound travels as small waves of pressure through the air at a speed of about 343 metres per second (740 miles per hour). The waves of sound are rather like ripples on the surface of a pond spreading out after a stone has been thrown in. These waves have pitch (frequency) and that is the number of crests that pass a point in a second. Pitch is measured as ‘cycles per second’ (cps) which is now more commonly written as hertz (Hz) after Heinrich Rudolf Hertz (1857–1894), a pioneering scientist who worked on theories of light and electricity; 261 Hz is equivalent to middle C on the piano.

One thousand cycles per second (1,000 cps) is one kilohertz (1 kHz). Sound waves also have intensity and, when the comparison is made with ripples on the pond, this equates to the volume of the wave. In real life, it is easier to measure the pressure of the wave rather than its intensity and this pressure is measured in units called pascals (Blaise Pascal [1623–1662] was, among other things, a mathematician and physicist of genius working on statistics, probability and geometry, and atmospheric pressure). One pascal is rather large for sound pressure measurements so that micropascals (µPa), that is, one-millionth of a pascal, tend to be used. The quietest sound that the average healthy 18 year old, without previous ear problems and with normal eardrums, can hear has a pressure of 20 micropascals (20 µPa). This level forms the basis for measuring the pressure of other commonly heard sounds in our environment. The range of pressures that the ear can hear is enormous.

The quietest, just detectable sound may be 20 µPa, but a jet engine heard close by has a level of 20,000,000 µPa. For convenience these levels are recorded as decibels (dB) after Alexander Graham Bell (1847–1922), teacher of the deaf and inventor of the telephone, the audiometer and gramophone, who derived a convenient way of expressing this huge range of sound pressures. HOW HEARING WORKS Sound waves are partly collected by the pinna, which in humans has only a limited function. You will have noticed how dogs prick up their ears in response to an interesting sound; this enables them not only to hear better but also to localise the source of a sound more accurately. In humans, the convolu­tions of the pinna do help a little in both respects, but complete loss of the pinna only reduces the hearing by a few decibels, although sound localisation is impaired. The ear canal not only protects the eardrum from direct damage, but also has a role in hearing.

The resonance properties of a tube that is open at one end and closed at the other result in sounds being enhanced over a certain frequency range at the closed end of the tube. The common example of resonance happens when you blow across the top of an empty bottle to produce a note. If the bottle is then partly filled with liquid, the note changes as the resonance properties change. For the dimensions of the human ear, this enhancement is most marked in the range 1,500–6,000 Hz which just happens to include most of the frequencies used for speech and sorting out one complex sound from another – for example, speech from background noise. The large area of the eardrum, which is not rigid but flexible and buckles slightly to help absorb energy, now collects the sounds. The hammer, anvil and stirrup transfer this sound energy to the relatively small area of the oval window. This system, which comprises the large flexible eardrum linked by a chain of bones with a small lever action to the inner ear, is really quite efficient in converting airborne sound waves into sound waves in the fluids of the inner ear. Normally, when sound hits the surface of a liquid, 99.5 per cent or more is reflected.

The operation of the middle-ear mechanism results in about 50 per cent of the sound reaching the eardrum being trans­ferred to the inner ear. As sound waves hit the peri­lymph beneath the footplate, they create a wave that travels up and around the cochlea. This travelling wave builds up to a maximum for each particular pitch and then rapidly falls away to nothing. The location of the peak of the wave varies at different pitches: for high-pitched sounds, the wave peaks near the base of the cochlea, whereas for low-pitched sounds this peak is near its apex. As this pressure wave passes through the cochlea, there is movement of the thin basilar membrane and, along with it, the organ of Corti containing the hair cells. Overlying the hair cells is a gelatinous membrane called the tectorial membrane. One edge of this is attached to the bony core at the centre of the cochlea (the modiolus); the other is loosely attached to the organ of Corti outside the outermost outer hair cell.

The tips of the hairs of the OHCs are lightly embedded in the under-surface of the tectorial membrane whereas the tips of the IHCs (which, as mentioned earlier, give rise to most of the nerve fibres) do not reach the tectorial mem­brane and stand free in the endo­lymph. As the travelling wave reaches its peak, the OHCs near this peak give a small, physical ‘kick’ to enhance the movement of the basilar membrane. This internal amplifier causes the endolymph to squirt towards the hairs of the IHCs. If the movement of fluid is great enough, the hairs are deflected and very small channels open up some­where near the tips of the hairs. The potassium in the endolymph can now flood down through these small channels, being propelled by the very strong positive electrical charge of the endolymph into the bodies of the IHCs. Here the influx of potassium alters the hair cell membrane and small parcels of chemicals are released from the base of the hair cell, causing the nearby nerves to become active and send pulsed signals towards the brain.

The signals pass from one relay station to the next in a regular fashion and have complex inter­actions in the brain stem. About one-fifth of a second after detection, electrical signals reach the auditory areas of the brain (auditory cortex of the temporal lobes) and sounds are perceived. At each step, the system is set to maximise sensitivity to sound. There is the very well-balanced middle-ear mechanism, which generates the pressure changes in the cochlea that result in the complex travelling wave; this, in turn, depends on the delicate fine structure of the cochlea. There is the highly unusual fluid named the endolymph and a quite remarkable internal cochlear amplifier. Why so? Quite simply, hearing is an impor­tant and efficient early warning system. Without good hearing most mammals would find it difficult to survive. THE MIDDLE EAR, EUSTACHIAN TUBE AND MASTOID In order to hear, creatures living on land need to have an eardrum with air on both sides to collect airborne sound and transfer it onwards to the inner ear.

Reptiles, birds and mammals all have the same system, although the numbers of bones are different in the three groups and birds have only one strut-like bone between the eardrum and inner ear. In mammals, the middle ear is lined with a tissue that is rather like the lining of the nose, with mucus-producing glands and cells with a surface covered by moving flexible hairs or cilia – not to be confused with the stereocilia of the hair cells, which are different structures altogether and which are not mobile. The middle ear is, therefore, an air-filled space, lined with living tissue capable of producing both debris from dead surface cells and mucus from the glands. This creates two problems: first, clearing the debris and mucus and, second, a more subtle but very important problem. Oxygen is absorbed from the air in the middle ear into the blood vessels running through its lining, in much the same way that oxygen is absorbed in the lungs. Some carbon dioxide is given off from those same blood vessels into the air in the middle ear, but overall the effect is a drop in middle-ear pressure as more oxygen is removed than carbon dioxide produced.

With atmospheric pressure outside the eardrum, something has to ‘give’ and the only thing that can move is the eardrum. This would be pushed inwards by the external pressure and the eardrum would then stop working normally. Eventually the whole middle ear would collapse and a significant hearing loss would develop. When working properly, the eustachian tube prevents both these problems. This tube runs forwards and inwards from the front wall of the middle ear to open into the back of the nasal cavity above the soft palate (the nasopharynx). The end nearer the nose is soft and flexible, and opens when you swallow or yawn. Although we do not know precisely how this mechanism works, when the eustachian tube opens, enough air enters the middle ear to replenish the oxygen that has been absorbed and so keep the middle-ear pressures close to atmospheric. It has been calculated that only one or two millilitres of air per ear per day – that is, less than half a teaspoon of air – are necessary to maintain proper ventilation of the middle ear, but without this the middle ear fails to perform properly.

The eustachian tube is also the conduit along which the cilia move the mucus produced in the middle ear to the back of the nose, where it can be swallowed. This thin film of mucus, carrying the debris produced in the middle ear, is moved along the floor of the eustachian tube with air passing above it to reach the middle ear from the nose. Thus, the two functions of ventilation and self-cleansing are achieved when the system is working properly. Unfortunately, in humans, the mechanism is rather fragile and often fails to work adequately, possibly because of the shape of the skull that is needed to accommodate the large brain. There is also an extension of the air-filled spaces of the middle ear backwards into the mastoid bone. You can feel this as a rounded bump if you put your hand to the back of your ear. The mastoid bone should be hollow, with the air-filled spaces broken up by small and incomplete bony partitions rather like a honeycomb. The average mastoid has an air volume of about 15–20 millilitres (three to four teaspoons) and this helps to buffer pressure changes in the middle ear and reduce adverse effects on the tympanic membrane.

People with small mastoid air spaces seem to be at a much greater risk of developing middle-ear and mastoid disease. As yet, we do not fully understand whether it is middle-ear and mastoid disease that cause the failure of the mastoid to develop, or whether a small size reduces the pressure buffer and therefore causes the development of disease. The probable answer is that it will be a bit of both. Earache: MedlinePlus Medical Encyclopedia Increased crying Irritability Many children will have minor hearing loss during or right after an ear infection. Most of the time the problem goes away. Lasting hearing loss is rare, but the risk increases with the number of infections. Causes The eustachian tube runs from the middle part of each ear to the back of the throat. This tube drains fluid that is made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. This may lead to pressure behind the eardrum or an ear infection . Ear pain in adults is less likely to be from an ear infection. Pain that you feel in the ear may be coming from another place, such as your teeth, the joint in your jaw ( temporomandibular joint ), or your throat.

This is called "referred" pain. Causes of ear pain may include: Arthritis of the jaw Ear pain in a child or infant may be due to infection. Other causes may include: Ear canal irritation from cotton-tipped swabs Soap or shampoo staying in the ear Home Care The following steps may help an earache: Place a cold pack or cold wet washcloth on the outer ear for 20 minutes to reduce pain. Chewing may help relieve the pain and pressure of an ear infection. (Gum can be a choking hazard for young children.) Resting in an upright position instead of lying down can reduce pressure in the middle ear. Over-the-counter ear drops can be used to relieve pain, as long as the eardrum has not ruptured. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can provide relief for children and adults with an earache. (DO NOT give aspirin to children.) Swallow or chew gum as the plane descends. Allow infants to suck on a bottle or breastfeed. The following steps can help prevent earaches: Avoid smoking near children. Secondhand smoke is a major cause of ear infections in children.

Prevent outer ear infections by not putting objects in the ear. Dry the ears well after bathing or swimming. Take steps to control allergies. Try to avoid allergy triggers. Try a steroid nasal spray to help reduce ear infections. (However, over-the-counter antihistamines and decongestants DO NOT prevent ear infections.) When to Contact a Medical Professional Call your health care provider if: Your child has a high fever, severe pain, or seems sicker than is usual for an ear infection. Your child has new symptoms such as dizziness, headache, swelling around the ear, or weakness in the face muscles. Severe pain suddenly stops (this may be a sign of a ruptured eardrum). Symptoms (pain, fever, or irritability) get worse or do not improve within 24 to 48 hours. What to Expect at Your Office Visit The provider will do a physical exam and look at the ear, nose, and throat areas. Pain, tenderness, or redness of the mastoid bone behind the ear on the skull is often a sign of a serious infection. Alternative Names Otalgia; Pain - ear; Ear pain Images Medical findings based on ear anatomy References Bauer CA, Jenkins HA.

Otologic symptoms and syndromes. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 156. Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010;304(19):2161-2169. PMID: 21081729 . Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3): e964-e999. PMID: 23439909 . O'Handley JG, Tobin EJ, Shah AR. Otorhinolaryngology In: Rakel RE, Rakel DP eds. Textbook of Family Medicine. 9th ed.

Philadelphia, PA: Elsevier Saunders; 2016:chap 18. Read More Ear, Nose, and Throat Facts | Johns Hopkins Medicine Health Library Ear, Nose, and Throat Facts See related health The ear is the organ of hearing and balance. The ear consists of: External or outer ear, consisting of: Pinna or auricle. This is the outside part of the ear. External auditory canal or tube. This is the tube that connects the outer ear to the inside or middle ear. Tympanic membrane (also called the eardrum). The tympanic membrane divides the external ear from the middle ear. Middle ear (tympanic cavity), consisting of: Ossicles. These are the 3 small bones that are connected and transmit the sound waves to the inner ear. The bones are called: Malleus Incus Stapes Eustachian tube. A canal that links the middle ear with the back of the nose. The eustachian tube helps to equalize the pressure in the middle ear. Having the same pressure allows for the proper transfer of sound waves. The eustachian tube is lined with mucous, just like the inside of the nose and throat.

Inner ear, consisting of: Cochlea. This contains the nerves for hearing. Vestibule. This contains receptors for balance. Semicircular canals. This contains receptors for balance. What is the nose? The nose is the organ of smell and is part of the peripheral nervous system. The nose consists of: External nose. A triangular-shaped projection in the center of the face. Nostrils. These are two chambers divided by the septum. Septum. This is made up primarily of cartilage and bone and covered by mucous membranes. The cartilage also gives shape and support to the outer part of the nose. Nasal passages. Passages that are lined with mucous membranes and tiny hairs (cilia) that help to filter the air. Sinuses. Four pairs of air-filled cavities that are also lined with mucous membranes. What is the throat? The throat is a ring-like muscular tube that acts as the passageway for air, food, and liquid. The throat also helps in forming speech. The throat consists of: Larynx. This houses the vocal cords and is crucial to speech and breathing.

The larynx also serves as a passageway to the trachea (windpipe to the lung). Epiglottis. This is located above the larynx and works with the larynx and vocal cords to push the food into the esophagus, therefore keeping food from entering the windpipe. Tonsils and adenoids. These are made up of lymph tissue and are located at the back and sides of the mouth. They protect against infection, but generally have little purpose beyond childhood. Experience Our Care Ear Tubes | American Academy of Otolaryngology-Head and Neck Surgery Patient Health Information News media interested in covering the latest from AAO-HNS/F can find information on embargoes, Annual Meeting press registration and more below. Please direct any interview requests or policy questions to our media and public relations staff at newsroom@entnet.org . Painful ear infections are a rite of passage for children and by the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own (viral) or are effectively treated by antibiotics (bacterial).

But sometimes ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues, such as hearing loss, poor school performance, or behavior and speech problems. In these cases, insertion of an ear tube by an otolaryngologist (ear, nose, and throat specialist) may be considered. What are ear tubes? Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes. These tubes can be made out of various materials and come in two basic types: short-term and long-term. Short- term tubes are smaller and typically stay in place for six to eighteen months before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long-term tubes may fall out on their own, but removal by an otolaryngologist may be necessary. Who needs ear tubes and why? Ear tubes are often recommended when a person experiences repeated middle ear infection (acute otitis media) or has hearing loss caused by persistent middle ear fluid (otitis media with effusion).

These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, poor school performance, or changes in the structure of the ear drum. Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure, usually seen with altitude changes as in flying and scuba diving). Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia. The average age for ear tube insertion is one to three years old. Inserting ear tubes may: Reduce the risk of future ear infection; Restore hearing loss caused by middle ear fluid; Improve speech problems and balance problems; and Improve behavior and sleep problems caused by chronic ear infections; and Help children do their best in school. How are ear tubes inserted in the ear? Ear tubes are inserted through an outpatient surgical procedure called a myringotomy.

A myringotomy refers to an incision (small opening) in the ear drum or tympanic membrane, which is most often done under a surgical microscope with a small scalpel. If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation). What happens during surgery? Most young children require general anesthesia but some doctors can do this as a brief office procedure. Some older children and adults may also be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the opening. Ear drops may be administered after the ear tube is placed and may be prescribed for a few days. The procedure usually lasts less than 15 minutes and patients recover very quickly. Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed for persistent middle-ear fluid.

This is effective for children four years or older and is often considered when a repeat tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes for persistent middle-ear fluid can reduce the risk of recurrent ear infections and the need for repeat surgery in children four years and older. What happens after surgery? After surgery, the patient is monitored in the recovery room (if general anesthesia was used) and will usually go home within an hour or two if no complications occur. Patients usually experience little or no postoperative pain, but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily. When done in the office recovery is immediate. Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery. Children with speech, language, learning, or balance problems may take several weeks or months to fully improve. The otolaryngologist will provide specific postoperative instructions, including when to seek attention and to set follow-up appointments. He or she may also prescribe an antibiotic ear drops for a few days. An audiogram should be performed after surgery, if hearing loss is present before the tubes are placed. This test will make sure that hearing has improved with the surgery.

Although the tube does have a small opening (about 1/20th of an inch) that could allow water to enter the middle ear, research studies show no benefit in keeping the ears dry and current guidelines do not recommend routine water precautions. Therefore, you do not need to restrict swimming or bathing while tubes or in place and do not need to use earplugs, head bands, or other water-tight devices unless specifically recommended by your doctor. Consultation with an otolaryngologist (ear, nose, and throat specialist) may be warranted if you or your child has experienced repeated or severe ear infections, ear infections that are not resolved with antibiotics, hearing loss due to fluid in the middle ear, barotrauma, or have an anatomic abnormality that inhibits drainage of the middle ear. Possible complications Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include: Perforation: This can rarely happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close.

The hole can be patched through a surgical procedure called a tympanoplasty or myringoplasty. Scarring: Any irritation of the ear drum (recurrent ear infections), including repeated insertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problem with hearing and does not need any treatment. Infection: Ear infections can still occur with a tube in place and cause ear discharge or drainage. However, these infections are usually infrequent, do not cause hearing loss (because the infection drains out), and may go away on their own or be treated effectively with antibiotic ear drops. Oral antibiotics are rarely needed. Ear tubes come out too early or stay in too long: If an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by an otolaryngologist. Copyright © 2015 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly prohibited without prior written permission.

External Link: Intranasal Treatment for Clogged Ears | Fauquier ENT Blog Intranasal Treatment for Clogged Ears at 10 COMMENTS A common cause of clogged ears with inability to pop them easily is due to eustachian tube dysfunction . There are a number of ways to address this annoying problem, but one of the first steps to try is intranasal medications whether in nasal spray form or nasal drop form. The whole idea behind intranasal treatment is the fact that the ears are connected to the back of the nose via a tunnel called the eustachian tube. Watch video explanation . Normally, when the ears are popped (also known as valsalva), the individual is opening up the eustachian tube to allow pressure and/or fluid in the ears to drain/escape out into the back of the nose. That's why when you blow your nose, you often hear a popping noise in the ears. Read more about how/why this happens here . Patients suffering from eustachian tube dysfunction are unable to get the tunnel to open up. In this scenario, the pressure or fluid remains trapped in the ear. It's a plumbing problem in its essence.

Given the problem is the eustachian tube, intranasal medications are used to try and open up the tunnel and make it easier for the individual to pop the ears open. Such medications include some combination of afrin , flonase , nasacort , rhinocort , etc. Trick is... how to get the intranasal medications to where the eustachian tube is located in the very back of the nose. There are a few ways to accomplish this... some which work better than others. Method 1: Use a nasal spray medication and aim the bottle to the back of the neck while keeping the head down (looking at the floor). The spray bottle MUST be perpendicular to the face. Why? Take a look at the diagram below: If you aim the bottle towards the eye or top of the head, the medication is hitting areas of the nose where the sinus cavities are... not where the eustachian tube is located. You have to look down and point the nasal spray bottle up towards the ceiling because all nasal spray medications use a straw that requires vertical orientation (same reason why when you drink Pepsi from a cup, the cup is upright).

Anatomically, the nasal spray "shoots" the medication straight up to where the eustachian tube is located. Method 2: Use an eye dropper and place a drop of the medication into the nose and have it "drain" to where the eustachian tube is located. Practically, this means filling a prescription of the nasal spray medication, opening up the bottle, and pouring the contents into an eye dropper. This method requires positioning the head such that gravity will ensure proper movement of the medication to where the eustachian tube is located. There are two ways to achieve this. This first way is the "Head-Tipped-Back Position". In this position, the nasal drop will "fall" down to where the eustachian tube is located: Mygind's Position is the alternative position which accomplishes the same thing, but the person is laying down looking up. For some people, this position is more comfortable than bending the head back. Studies have shown that Method 2 (nasal drops) works better than Method 1 (nasal spray). However based on my personal experience in my patient population, Method 2 is not as well tolerated as Method 1.

People often feel like drowning or suffocating when performing this maneuver (mini water-boarding so to speak). Also, it seems to be more irritating to the mucosal lining of the nose and throat. And as we all know, if it is not comfortable or user-friendly, patients will not do it. As such, I usually recommend Method 1 (nasal spray) which works "good enough". For patients who are ambitious and are willing, go with Method 2 (nasal drop). Reference: How Can Nasal Obstruction CAUSE Clogged Ears? | Fauquier ENT Blog How Can Nasal Obstruction CAUSE Clogged Ears? at It is not uncommon that patients who suffer from a clogged nose also develop clogged ears . Why??? There are 2 major and 1 minor reasons. First a little anatomy lesson. In the back of the nose, there is an opening that leads into a tunnel (eustachian tube) that goes up into the ear. When the ears get clogged, a person can get the pressure out by " popping the ears ." This can be accomplished by yawn, swallow, or trying to blow out the nose that is pinched shut.

When the ear pops, what happens is that the tunnel opens up allowing pressure to come out the ear. Watch video : Mucosal Swelling Now when the patient's nose gets obstructed , it may mean the nasal lining has become swollen making it difficult to breath. It also means the tunnel that goes up into the ear may be swollen shut as well. As such, it may become difficult if not impossible to pop the ears. This is known as eustachian tube dysfunction . Negative Pressure Inside the Nose However, there is a more active process that may lead to ear clogging beyond just mucosal swelling of the eustachian tube. When the nose is obstructed, every time the patient tries to breath in thru the nose, negative pressure is built up in the back of the nose where the eustachian tube opening is located. As such, this negative pressure inside the nose can get transmitted up into the ear resulting in negative pressure to slowly build up in the ear as well which can ultimately cause a clogged ear sensation .

This is just like sucking on a straw to draw fluid out of a cup, though in this case, the straw is analogous to the eustachian tube, the fluid is air, cup is the ear, and the mouth is the nose. Bernoulli's Principle In fluid dynamics, Bernoulli's principle states that for an inviscid flow, an increase in the speed of the fluid occurs simultaneously with a decrease in pressure. To use an example, if you are driving a car with the window down, the fast-moving air outside the car creates a negative pressure inside the car causing things to not just blow around, but does cause some suction effect to things within the car (paper inside the car potentially getting "sucked" to the outside). When the nose becomes clogged, airflow increases in the back of the nose (think garden hose where you have the same amount of water flow, but by changing the nozzle diameter, flow can be increased by making diameter smaller or decreased by making diameter larger). Due to Bernoulli's principle, negative pressure builds up inside the ear due to this increased nasal airflow. This negative pressure can be transmitted into the ear causing it to become clogged. So there you have it...

3 reasons why a clogged nose can lead to clogged ears! That also means that often, if you just treat the clogged nose... the clogged ears will get better as well! Reference: Upper airway obstructions and chronic otitis media: A clinical study . American Journal of Otolaryngology - Head and Neck Medicine and Surgery. Volume 35, Issue 3 , Pages 329-331, May 2014 A few things that have helped some people to pop their ears: Labels: bernoulli's , clogged ears , clogged nose , deviation , dysfunction , eustachian , nasal obstruction , negative , popping , pressure , principle , septal , tube , turbinate , valsalva Fauquier ENT Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio 1 comment:

Question: What name is given to the tube which runs from the ear to the back of the nose?
Answer: EUSTACHIAN TUBE